Abstract Body: Background: According to the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhages (SAH), early treatment of ruptured aneurysms reduces the risk of repeated bleeds and facilitates treatment of delayed cerebral ischemia. Efficient aneurysm securement in the hospital setting is critical to survival; however, analysis of aneurysm timing and care in the pre-hospital setting is difficult. In this quality improvement study, we reviewed hospital data to improve our outcomes for patients with aneurysmal SAH.
Methods: We conducted a retrospective analysis of hospital outcomes and stroke metrics for 72 patients with last known well times who underwent securement for aneurysmal SAH at a comprehensive stroke hospital in upper Midwest from Jan 2016 to Jul 2024. Data were compiled from multiple resources including Get-With-The-Guidelines®, chart abstraction, and internal healthcare databases. We compared 0-24 hours (n=49) and >24 hours (n=23) ‘Onset to Treatment’ groups using appropriate statistical tests and significance was determined using a two-sided alpha of 0.05.
Results: Demographics (age, sex), cerebrovascular risk factors (hypertension) were similar between both groups. No differences were noted in the size or location of aneurysm. Interestingly, the symptom presentation (altered level of consciousness [48% (0-24), 26% (>24)]) and severity were higher in 0-24 group, including the NIH stroke scale (p-0.04), Hunt and Hess score (p-0.06), and Glascow Coma Scale (p-0.05). Modified Rankin scale (mRS) least favorable outcomes (5 and 6) were higher in 0-24 group (33% [0-24],17.3% [>24]) and more external ventral drains were placed (70% [0-24], 57% [>24]), though no change in overall hospital outcomes was noted, including mRS at discharge and discharge disposition between the groups. No differences were noted in ‘Door to Treatment’ times between the groups (12 [0-24] vs 14 hours [>24], p-0.16).
Conclusion: At our hospital, there were no significant differences in overall outcomes for patients treated before or after 24 hours of symptom onset for aneurysmal SAH. Additionally, no impact of ‘onset to door’ times on hospital metrics for securement was noted. Lastly, an interesting trend in patients who arrived within 24 hours of symptom onset had a higher severity of symptoms, greater complications, and an increase in least favorable outcomes, suggesting the importance of early recognition and education regarding SAH presentations.